We asked some of our providers to share their tips & tricks for placing and removing engagers.

Nothing here should be taken as official advice or recommendation from ClearCorrect or its employees. It’s up to you to use your professional judgement on what is best for you and your patients.

As the clinician it is important for you to be aware of different approaches, so that you can customize treatment for each patient. By way of example, while it may be possible to place engagers all at once in one patient, it may be necessary to cut the engager template and place engagers separately for another patient. Another example is the availability of various composite resins. Some patients seem to have no problems with engagers made from flowable resins, and with others they can wear away and break down. In this situation, a filled resin or other more durable resin can be used.

We wanted to pass on some of these responses in hope that you might find them useful in treating your patients.

Tips and tricks on engager materials/composite/flash

Doctors who preferred flowable said:

“I use only flowable composite to fill the engager templates. It is easier and fills the template without voids. I know you recommend a two fill system, but it doesn’t seem there is time to do that and still get a good fill. I have had good luck so far with my variation of your system.”

“When placing engagers, use a little drop of flowable to “wet” the inside of the well prior to injecting paste, then a dab of flowable to “wet” the interface of paste and tooth when going to mouth.”

“Flowable composite seems to work best versus packable products. Also, checking the bite after placing engagers can prevent some engagers from interfering with the bite and being dislodged. “

“A “thick” flowable resin like GC Universal Flo will work well, without need for two materials, thin flo and thick paste.”

“I use flowable composite first, then a filled resin when filling the template.”

“The combo of flowable composite placed on the etched, primed/bonding agent light cured teeth and heavier composite place in the lubed engager reservoir works predictably on seating and curing. The sandwich of light and heavy composite will leave some flash to remove.”

Doctors who preferred different composites & bonds said:

“Using a lower viscosity composite, but not flowable.”

“Blue phosphoric acid etch bonds better.”

“I use a packable composite and place the college plier’s tips in either embrasure, forcing the aligner into closer contact with the tooth.”

“Use cheek retractors, spot etch, bond and use Surefil flow, which has been my best result in placing engagers.”

On the topic of flash, doctors said:

“I find that if I leave a little flash they stay on better.”

“They key is high speed finishing off any flash or over extension of composite. Wearing an LED headlight with loops and air drying the tooth/engager composite junction shows excess flash the best. Always verify that the next corresponding aligners seat completely in the excess flash removal evaluation. I use yellow or red striped carbide finishing points (like a 7901 or 7102) to remove the flash. Remove some with a high speed and water spray, air dry, repeat until satisfied and remember less is more.”

Tips and tricks for attaching engagers

Doctors offered us a multitude of tips on technique, tools and even timing for placing engagers. Here’s what they had to say:

Doctor’s tips on engager placement techniques:

“Poke a small hole through the engager tray from the inside of the engager area to extrude excess air and composite material, then perform minor adjustment on the surface of the engager to smooth if necessary.”

“Using a very small bur the diameter of an adhesive tip (I use Flow Tain with disposable tip), drill a small hole in middle of engager on the template. Prep the tooth as recommended, place template on the teeth and then fill the engager bubble with adhesive through the hole. This ensures the correct amount every time.”

“For placing engagers, pre-load composite in wells, cover from light bonding procedures, then directly to mouth, less change for salivary contamination by pre-loading.”

Doctors tips for engager template removal:

“The composite tends to stick to the template tray unless you wipe with alcohol and then apply the Vaseline.”

“I cut up the engager template and only attach 2 at a time.”

I usually cut the template. I keep 3 teeth, the engager tooth and the 2 adjacent teeth on each side. That way it will be easier to remove the template once the engager is placed.”

“Trays definitely need modification prior to placing engagers. I separate the right & left sides, and remove the lingual portion of the tray just past the incisal edge. This way I can peel the tray off easily. I also place a light coat of Vaseline with a micro brush on the inside surface of the tray where the composite will go.”

“On the template for the engagers, I remove the aligner material on the gingival side just below each engager well, right up to the edge of it, either with a high speed hand piece or a hole punch. Removing the gingival area below the engager wells allows me to wipe away any excess composite material that extrudes out of the gingival side of the engager well. It also provides me a purchase point to be able to lift up the template off of each tooth that has an engager.”

Doctors tips on tools to use for engager placement:

“I do better with composite out of a fine needle syringe. It seems to be strong enough to hold up, but there is some excess flash that needs removing.”

“Attaching with Filtek Ultra resin worked so much better than anything else for me. Microetching first is a must.”

“Pumice and selective acid etching before regular bonding routine.”

Doctor’s tips on timing of engager placement:

“Attaching to rotated lower canines always presents a challenge because of the super-acute angles between the canine and the adjacent incisor. You should request to hold placement of those engagers until the last possible time during treatment.”

“Sometimes to ensure proper placement, I will have the patient wear the trays for one week and then come back and place the engagers.”

Tips and tricks for removing engagers

Based on our responses, doctors seem to favor burs and using a combination of burs, discs and polishers.

Doctors who preferred burs said:

“I find that the best FINAL tool is a small pointed low-fluted carbide bur.

“To remove engagers, I use a diamond finishing bur to remove the bulk and then switch to a Softlex disc for the final removal.”

“I first use a scaler, then Soflex discs, dry to better visualize the borders of composite. I check with the side of an explorer to see if the composite abrades some metal or if is completely removed.”

And some doctors prefer other tools:

“Remove with a white stone and high speed hand piece.”

“Use a high speed dry (no water so you can see the difference between the composite and the tooth structure, then use composite polishers to finish.”

“I use a fine diamond for gross reduction and finish with Dentsply enhance.”

“Use G-Bond provided by ClearCorrect, red stripe (fine) bur to remove 90%, then usually I’m able to flake off with a scaler. Not fun but it works without damaging the enamel.”

“Dura white stone high speed ulta dent polishing brush.”

“I like to remove the final layer of composite with a Brownie point, at a reduced speed.”

Doctor’s tips on engager removal techniques:

“I like to polish after removing engagers to make sure all is smooth.”

“Have patience in removing. Using a porcelain polishing diamond wheel works very well. When the resin is very thin a scalpel can be used or a rubber resin polisher will help remove resin without removing enamel.”

“Use a fluoride treatment after removal.”

Tips and tricks for lubricating

Doctors offered us several different tips for lubricating the engager template before installing, helping with template removal.

“Lubricate the template with Vaseline.”

“Apply mineral oil to the aligner beforehand so engagers don’t come off in the tray.”

“Make sure template is thoroughly coated with a separator and pull template away facially not incisal after curing.”

“Your seating video is spot on. The key is to lube the engager housing with either a dab of Vaseline or separating liquid (Sure Sep by Belle de St. Claire lab products).”

“We coat the template with Pam cooking spray before bonding the engagers. It makes it easier to remove the template. With multiple engagers the bonding material would sometimes fracture during template removal before using the releasing agent.”

“I find that the template needs to be wiped with alcohol before using Vaseline. My guess is that there is some type of oxygen inhibiting layer that the composite sticks to.”

“I spray the inside of the aligner with a light mist of non-stick cooking spray and then air blow it out of the engager well, not allowing any to pool up but still leaving a thin amount of separating medium. The separating medium in the template helps prevent the composite from bonding to the template and also aids in disengaging the template from the teeth which minimizes the engagers popping off.”

General tips and tricks regarding engagers

From installation techniques and engager modification to patient preparation, here are some general tips offered from providers.

“The engagers are pretty sharp to the lip so I always polish them a bit.”

“ Have the patient wear the engager stent/tray for at least a week before placing the engager.”

“I do one quadrant at a time. Usually there’s an area on the tray that serves as the best point for removal. You may want to consider adding something similar to a removal button on PFMs.

“Important to place pressure on the template from buccal and lingual. This ensures the engager is not too thick.”

“Magnification is a must.”

“Keep area clean and dry. Etch the enamel very thoroughly. Fill template and push the material into each attachment to adapt it well.”

“I make sure to abrade the enamel slightly with air abrasion or diamond and then etch. I fill with composite slightly below level, then place a dot of flowable composite to fill the last bit so it is level before placing in the mouth.”

“I always round them just a little after I place them. They seem to work fine and it makes the trays easier to insert and remove. I know that could cause some trouble at some point, but so far it has not.”

“I do them one at a time so I can press the engager matrix hard against the tooth with the back of the tips of a cotton forceps.”

“You should overbuild the engager and reapply material if it does not look accurate.”

“Sometimes we like to modify the tray and enlarge the engager to act as a hook and use the engager with elastics/rubber bands to help super erupt a tooth.”

“We prefer longer treatment without engagers than shorter treatment with engagers. We also prefer to have engagers removed at the earliest possible step instead of waiting until treatment completion.”

“I try to always prepare people for engagers: “You’ll have a big, tooth-colored blob on these three teeth…etc. This way they don’t freak out: “You told me I could take them out but I can’t take this blob out!”